The climate in Congress makes at least some change at the VA likely, though a complete overhaul of the troubled agency is doubtful.

PHOENIX – It seems nearly every day there’s more bad news about the U.S. Department of Veterans Affairs and how it has treated those who served in the military.

Whether it’s confirmation that veterans died while awaiting care, patient wait-time records being manipulated to trigger staff bonuses or the VA consistently ignoring whistle-blower warnings about dangerous practices, it’s been a particularly embarrassing time for the VA.

In Congress, a bipartisan House and Senate committee met for the first time June 24 to craft legislation to change the way the nation’s largest integrated health care system does business. Lawmakers are hoping to reconcile elements of a House-approved bill and Senate legislation.

President Barack Obama last week set the stage for internal change at the VA, nominating West Point graduate Robert McDonald, most recently CEO and chairman of Procter & Gamble, as the new VA secretary.

Obama also discussed his outlook for administrative revisions that, while not remaking the agency, could change every veterans’ health care experience at the VA. Among them: hiring more medical professionals, paying closer attention to whistle-blower complaints, and seeking authority for the VA secretary to fire senior leaders who are now protected by statute. The climate in Congress makes at least some change at the VA likely, though a complete overhaul of the troubled agency is doubtful. The VA health care system is just too big, and its customers — veterans — are loyal despite the problems that ignited the scandal.

Congress also has limited time and political will for major reform, given approaching elections.

Lawmakers are considering a VA package that some congressional analysts say will cost more than $35 billion. Even if lawmakers pay for more doctors, specialists and nurses and implement changes making it easier to fire hospital administrators and managers, will it be enough?

Sen. John McCain, R-Ariz., a member of the House and Senate Veterans’ Affairs Conference Committee, isn’t sure money alone will fix the problems. And he’s not alone in his skepticism. Veterans groups and those who monitor health care say the VA has a herculean task.

“Unless we change the way the VA does business, we will not change anything,” McCain said.

But cost has already become an issue. McCain says the Congressional Budget Office’s estimate of the Senate VA reform bill cost is too high. The competing House VA bill’s cost is projected at $44 billion.

McCain said he was confident a compromise would allow VA legislation to pass this month at a cost lower than CBO’s $35 billion estimate.

“It has to,” he said. “The American people will demand it.”

He called fixing the VA “the definition of an emergency.” But even if Congress allows veterans to get expedient care, he said the agency won’t truly become healthy unless there is a complete change in leadership.

Two veterans groups agreed with McCain that the VA won’t solve its problems without new leadership.

“Right now is the best time to reform the VA,” said Ralph Bozella, chairman of the American Legion’s National Veteran Affairs and Rehabilitation Commission. “What they need is a cultural change in the organization.”

The Legion, with 2.4 million members and nearly 14,000 posts across the country, was one of the first groups to call for the resignation of former VA Secretary Eric Shinseki.

Dan Caldwell, an executive with Concerned Veterans for America, said the VA culture will change only if there are numerous personnel changes at the VA central office in Washington, D.C., and if dozens of hospital administrators are removed.

“There is no accountability. There is a belief in the VA that they are doing fine and it doesn’t matter,” said Caldwell, who noted it can take months to terminate a federal employee.

Rep. Ann Kirkpatrick, D-Ariz., is among members of Congress who have called for more accountability.

Kirkpatrick, also a member of the House and Senate Veterans’ Affairs Conference Committee, said the VA needs funding to upgrade software to improve patient scheduling. She also said the VA should hire an outside scheduling expert.

Heather Ross, a clinical instructor at Arizona State University who studies complex health care systems, said the scheduling system at the VA is “fundamentally broken.”

Until it is repaired, she said, it will remain difficult to accurately schedule patients because of outdated technology to track veterans.

Ross said there should be consequences for staff who manipulated patient wait-time records but “firing people will not fix the problem.”

Besides improving its technology, the VA needs better data on patient demand to allocate resources, said Phillip Carter, senior fellow and director of veterans research at the Center for a New American Security.

Carter added that the VA should further leverage the private sector for non-service-related care and use provisions under the Affordable Care Act as an option for veterans’ health care.

Robert Book, senior research director at the Health Systems Innovation Network, a health-policy consulting firm, said one alternative to direct health care from the VA is for the agency to subsidize veterans’ private health insurance, using a sliding scale based on the current priority criteria for veteran-care eligibility.

“With a very few exceptions, most of the health care needs could be met by paying civilian doctors and civilian hospitals,” Book said.

Marc Landy, a Boston College political science professor, said the organizational structure of a federal agency like the VA is not set up to efficiently provide health care. “It is always surprising how much trouble these big federal departments have in creating sensible command structures. This is, horribly, not unique to the VA.”

He said the political ramifications of decentralizing and outsourcing VA care in the long run would likely result in job cuts and a decreased role for the VA health care system. Congress will not want to permanently relinquish control over the VA, he said.

“That’s why it’s very important to do this now. It seems to me, with congressional elections coming up, there’s advantage to improving the VA. It’s not a partisan matter. Both parties love the veterans,” Landy said.